DR. MICHAEL DEAN MEDLOCK MD NPI 1902887185

NPI Information

NPI: 1902887185
Provider Name: DR. MICHAEL DEAN MEDLOCK, MD
Classification: Preventive Medicine - 2083A0300X
Entity Type: Individual

Specialization: Addiction Medicine

PECOS Registration: Yes

Address:
47 CONGRESS ST
SALEM, MA
ZIP 01970
Phone: (978) 744-8388
Get Directions

DR. Michael Dean Medlock, MD is an addiction medicine preventive medicine in Salem, MA with 40 years of experience. The provider is a physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction. DR. Michael Dean Medlock, MD NPI is 1902887185. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Graduation Year:1984

The provider's business location address is:

47 CONGRESS ST
SALEM, MA
ZIP 01970
Phone: (978) 744-8388

The NPI 1902887185 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/7/2005 and was last updated on 11/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207T00000X	Neurological Surgery		79690	MASSACHUSETTS	No
2	208000000X	Pediatrics		79690	MASSACHUSETTS	No
3	2083A0300X	Preventive Medicine	Addiction Medicine	79690	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11000546A	MEDICAID	MASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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